Prueba de Fuego: Reflections on HIV Testing from Nicaragua

The World Health Organization (WHO) has estimated that 80 percent of people currently living with HIV in developing countries do not know that they are HIV-positive—a statistic that has led policymakers and HIV/AIDS activists around the world to increase their efforts to ensure that people know their HIV status. In practice, this means making sure that testing facilities are in place, and that people are going to get tested. More broadly, it also means providing people with the support they need on discovering their HIV status: making sure that people know where they can access ARVs (antiretroviral drugs), for example, or recognizing and addressing the stigma, discrimination, exclusion, and violence that HIV-positive people often face on making their status public. It means making sure that HIV-positive people have the information and the tools they need to avoid transmitting the virus to their partners, and that the people around them understand how HIV is transmitted, so that they can continue to provide love, support, contact, and care without feeling as though they are putting themselves at risk of contracting the virus. To address these issues and many more, UNAIDS and WHO have recently released a new guidance on HIV testing and counselling, intended for use in health systems worldwide.

As the UNAIDS and WHO guidance recognizes, putting testing services in place is just the tip of the prevention iceberg. In our efforts to encourage people to get tested, we also have to think about the multiple, complex reasons why people might not want to know their status. Anyone who has ever had an HIV test themselves knows that it is a terrifying experience—whether or not you feel you have put yourself at risk. And who wants to voluntarily confront that fear, when there are so many risks that feel more immediate in our lives? Furthermore, no matter how prevalent HIV is where we live, we often don't feel that we are even at risk.

In Nicaragua, where I recently spent nine months working with an organization called Puntos de Encuentro, the epidemic is still not very widespread—official figures show that out of a population of around 5 million, just over 2,000 Nicaraguans are currently living with HIV/AIDS (although the real figures are probably higher). In a country with no sexuality education to speak of, a weak health system, and a culture of machismo that leaves women with little control over their sexual and reproductive lives, young people and women face particular HIV risk, and their infection rates are climbing. But young people and women are already up against so much, you can't blame them for putting HIV on the backburner as they go through the daily risk assessments that structure their actions and decisions. As Puntos' executive director pointed out in 2001:

If people don't perceive risk, it's possibly because so many other risks are so much closer to the surface: war, informal armed conflict, natural disasters like Hurricane Mitch, getting assaulted in the street, getting in a car or bus accident, dying from hemorrhagic dengue or a botched abortion or diarrhea. In spite of such widespread poverty, the possibility of dying of hunger is a new clear and present danger. And at the moment, teen suicide is more of an epidemic than AIDS.

In this environment, Puntos develops media that attempt to promote social change by portraying how people actually live their lives and make their decisions—amidst the complexities and contradictions of daily life. The point of Puntos' media is not to get people to act a certain way, it's to encourage them to think and act for themselves, in possession of the information and support we all need to make changes in our lives. Their weekly telenovela (TV soap opera) Sexto Sentido tackles topics that are often considered taboo—sex and sexuality, diversity and difference, reproductive decision-making, and young people's right to decide for themselves, to name a few. Through the stories, struggles, and triumphs of several characters, they have taken a long and complex look at the issue of HIV/AIDS.

The Sexto Sentido TV special edition called Prueba de Fuego("Trial by Fire" or "Rite of Passage" in Spanish) takes on the issue of HIV testing, following the testing experiences of four separate characters—a gay mestizo man, a straight Afro-descendent man, and two straight mestizo men—and going on to follow the story of one character who finds out that he is HIV-positive. The segment focuses on how race, gender, and sexuality structure our assumptions about whether or not we are vulnerable to HIV, as well as other people's assumptions about who we are and what we must have done if they find out that we are HIV-positive. Ultimately, however, it is about how even the worst news can sometimes free us to begin to really live our lives.